Dental Emergencies

Although dental emergencies and injuries can cause excruciating pain, they are also very common. About one a third of children have experienced some form of dental trauma, and more have had a dental emergency.

There are two periods with the highest risk of dental trauma – the first-period being toddlerhood (around 18-40 months) when the child starts exploring the environment, and the second period is adolescent/ preadolescent stage when there is a common occurrence of sporting injuries.

Here are some common childhood emergencies as well as how to deal with them:

Toothache

This affects children of all ages and it often occurs for a reason. Impacted food can make children uncomfortable and can be removed using dental floss, a clean finger, or a toothbrush. Consult the pediatric dentist if pain persists. Common causes of a toothache include tooth trauma, fractures, tooth decay, and the eruption of wisdom teeth (adolescence).

How you can help:

Use warm water to cleanse the area. Do not warm or medicate the adjacent gum or affected tooth area.

Remove impacted food when noticed

Apply a cold compress to reduce swelling in the affected area

Consult and seek advice from the pediatric dentist

Dental avulsion (knocked-out tooth)

If there’s a tooth in the child’s mouth that has been completely knocked out, you should get in touch with the pediatric dentist immediately. Generally, pediatric dentists do not try to reimplant baby teeth, because the procedure can be harmful to the tooth bud, and could negatively affect the emerging permanent tooth.

Pediatric dentists always choose to reimplant permanent teeth, unless an irreparable damage has been caused by trauma. The reimplantation has a higher success rate if performed within an hour of the avulsion, so time is crucial!

How you can help:

Recover the tooth. Avoid touching the roots! Handle only the crown.

Use water to off debris without scrapping or scrubbing the tooth.

For children who are older, place the tooth back to its original socket, or ask the child to place the tooth in the cheek pouch. For children who are younger, allow the tooth to be submerged in a glass of saliva or milk (do not try to reinsert the tooth if it swallowed by the child.

Never let the tooth dry during the course of transportation. Moisture is of critical importance to the success of implantation.

Consult the pediatric dentist (when you can) or let the child visit the emergency room immediately – time is crucial when it comes to saving the tooth.

Dental intrusion (tooth pushed into jawbone)

Sometimes a tooth (or several teeth) may be forced upwards into the jawbone. The prognosis tends to be favorable for teeth that have been pushed up to a lesser extent (less than 3mm), but not all situations are the same. In most cases, the force that accompanies the trauma is to cause injury to the ligaments and fracture its socket.

If you suspect that there is a dental intrusion of the permanent or primary teeth, you should get in touch with the pediatric dentist immediately. Depending on the depth and type of intrusion, the pediatric dentist will either let the tooth descend naturally or preserve the tooth structure by performing root canal therapy.

How you can help:

Use water to rinse the mouth of the child.

Reduce swelling by placing ice packs around affected areas.

Relief pain by offering Tylenol.

Get in touch with the pediatric dentist where you can, or go the emergency room.

Tooth luxation/extrusion/lateral displacement (tooth displacement)

Tooth displacement is also generally referred to as “extrusion,” “luxation,” or “lateral displacement,” depending on the tooth’s condition following trauma. A tooth that is luxated will stay in the socket – and the pulp remains intact 50% of the time. However, the tooth has an unfavorable protrusion, with the underlying jawbone fractured most of the time.

“Extrusion” is a term used to describe a tooth that is already partly removed from its socket. In children, primary tooth extrusions seem to possess the capacity to heal themselves without any medical treatment. However, in order to save the tooth and prevent infection, dental treatment should be considered for any form of permanent teeth displacement. If you suspect a displacement, it is best to get in touch with the pediatric dentist.

How you can help:

Use a moist or cold cloth to apply pressure on the affected area.

Provide pain relief (e.g. Children’s Tylenol).

Get in touch with the pediatric dentist immediately.

Crown fracture

The crown is known to be most visible and the largest part of the tooth. In most cases of trauma, the crown is usually the most affected. A crown fracture can be classified into various parts, ranging from pulp exposure (which requires immediate treatment) to minor enamel cracks (which do not require immediate attention).

The pediatric dentist can use dental x-rays to evaluate the severity of the fracture, if there is any change in color (e.g. yellowish or pinkish patches inside the tooth), it is an emergency signal. Dental sealants are often applied on minor crown fractures, whereas pulp treatment is used for more severe fractures. If a crown fracture occurs, you should contact the pediatric dentist. Jagged enamel can cause the irritation and inflammation of soft oral tissues, resulting in infection.

How you can help:

Use warm water to rinse the mouth of the child.

Use a moist or cold cloth to apply pressure on the affected area.

Provide pain relief (e.g. Children’s Tylenol).

Pack the tooth with a biocompatible material.

Visit the emergency room or the pediatric dentist depending on availability and severity of the injury.

Root fracture

A root fracture is usually a consequence of direct trauma, and it is hardly noticeable to the naked eye. Dental x-rays should be carried out if there’s a suspicion of root fracture. Depending on the amount of discomfort the child feels and the exact position of the fracture, you can still get the tooth examined, treated, or even extracted.

How you can help:

Use a moist or cold cloth to apply pressure on the affected area.

Provide pain relief (e.g. Children’s Tylenol).

Consult the pediatric dentist.

Dental concussion

A tooth that is yet to be fractured or knocked off its socket has taken a knock or bang, can be said to be “concussed.” A dental concussion is common in toddlers and causes temporary or permanent discoloration of the tooth. Unless the color of the tooth turns black (which indicates that the tooth is dying and maybe requiring a root canal therapy), a dental concussion is not treated as an emergency.

Injured lip, tongue or cheek

If a child begins to bleed in the cheek, tongue or lip as a result of an accidental bite or cut, apply some direct pressure on the affected area using a clean gauze or cloth. Apply ice on the area to reduce swelling. If the bleeding does not stop, call a medical professional or go to the emergency room immediately.

Fractured Jaw

If a fractured or broken jaw is suspected, go to the emergency room immediately. But in the meantime, the child can be encouraged to move the jaw. If it’s the case of a toddler, you can tie a scarf lengthways around the jaw and head to help prevent movement.

Head injury/head trauma

If the child has suffered trauma to the head, go to the emergency room immediately. Even if the patient is still conscious, it’s important for pediatric doctors to rule out internal bleeding and delayed concussion.